Shoulder pain is one of the most common pains in the musculoskeletal field and can be linked to several disorders. We spoke to Dr. Mario Borroni, of the Orthopedic Shoulder Surgery Unit in Humanitas.

The shoulder is the most complex joint in our body and is the one we use the most. The clavicle, scapula and humerus form the bone structure while the rotator cuff (made up of four muscles and their tendons) contributes to the joint movement and stability of the shoulder.

“Shoulder pain can result from a degeneration of cartilage caused by osteoarthritis (especially in old age). Another reason may be an inflammation involving the tendons, particularly the rotator cuff, which includes the four tendons anchored to the head of the humerus. Doctors have also described a situation that affects women usually between 40 and 60 years. This is calcific tendinopathy, which implies the presence of tiny stones (calcium deposits) in the thickness of the tendons” explains Dr. Borroni.


Instability of the shoulder in young people

A sore shoulder, especially at a young age, may be linked to instability. Dr. Borroni explains that “In order to function as it should, the shoulder works on a delicate balance between movement and stability, a mix ensured by a diverse range of structures: muscles, tendons, ligaments and capsules. In some patients, especially adolescents, this balance can be affected, so the shoulder moves a bit too much. You do not get actual dislocations, but the movement is not quite natural.”


Inflammation of the tendons

Inflammation of the tendons often affects those who perform activities that involve repetitive lifting and upper limb protraction. Examples are hairdressers, masons, tennis players, volleyball players and swimmers. In the long term inflammation can cause breakage. “Consider that one in two people over the age of 65 have a more or less serious rupture of a tendon in the rotator cuff. But the lesion is not always a source of pain and discomfort. This is because their shoulder, despite the damage, is not unstable and knows very well how to compensate for the problem. ”


How to cure a sore shoulder?

Specialist examination and x-rays are the first step; a doctor may later take the path towards surgery because a valid prescription for all does not exist. The surgery will mend the broken tendon or consolidate unstable shoulders with any bone grafts. In extreme cases we may replace the entire joint with a prosthesis, similar to the hip or knee.

Physiotherapy works with a series of targeted therapeutic exercises. Strengthening the muscles, reeducating joint movement and forming a more balanced shoulder even in the presence of a tendon injury.” explains Dr. Borroni.

Physiotherapy may involve useful shock waves, ultrasound and Tecartherapy, depending on the case. Dr. Borroni, explains that: “Shock waves generally used, but not all patients will derive benefit. Inflammation of the tendons and tendon calcification are very effectively treated with shock waves. However, in the presence of a tendon tear, it makes no sense to apply shock waves. On the other hand, the waves activate the probe in the shoulder tissue, stimulating blood vessels which help nourish and oxygenate the inflamed area.”